rthostatic hypotension is a common problem among elderly patients, associated with significant moridity and mortality. While acute orthostatic hypotension is usually secondary to medication, fluid or blood oss, or adrenal insufficiency, chronic orthostatic hypotension is frequently due to altered blood pressure egulatory mechanisms and autonomic dysfunction. The diagnostic evaluation requires a comprehensive istory including symptoms of autonomic nervous system dysfunction, careful blood pressure measureent at various times of the day and after meals or medications, and laboratory studies. Laboratory nvestigation and imaging studies should be based upon the initial findings with emphasis on excluding iagnoses of neurodegenerative diseases, amyloidosis, diabetes, anemia, and vitamin deficiency as the ause. Whereas asymptomatic patients usually need no treatment, those with symptoms often benefit from stepped approach with initial nonpharmacological interventions, including avoidance of potentially ypotensive medications and use of physical counter maneuvers. If these measures prove inadequate and he patient remains persistently symptomatic, various pharmacotherapeutic agents can be added, including udrocortisone, midodrine, and nonsteroidal anti-inflammatory drugs. The goals of treatment are to mprove symptoms and to make the patient as ambulatory as possible rather then trying to achieve arbitrary lood pressure goals. With proper evaluation and management, the occurrence of adverse events, including alls, fracture, functional decline, and myocardial ischemia, can be significantly reduced. © 2007 Elsevier nc. All rights reserved.